Paintsville Independent Schools' Enrollment Form
Student's First Name
Your answer
Student's Middle Name
Your answer
Student's Last Name
Your answer
If you completed an online application last year and would like to submit the same information as last year, check "Yes", proceed to Page 5, add a digital signature and then submit.
Student's Address
Your answer
Student's Mailing Address (if different)
Your answer
Student's Birthday
Your answer
Student's Social Security Number
Your answer
Student's Grade
Student's Race
Student's Gender
I grant permission for the school to administer over-the-counter or prescription medications provided by educational guardians. Please inform the School Nurse when you need this service.
Please list any medical issues of the Student that need to be made known to school personnel?
Your answer
Would you like the School Nurse to contact you about this issue?
Does the Student have any known allergies? If your answer is yes, please respond to the next two questions.
Known Allergies
Your answer
Is an Epipen required?
What is the student's first-learned language?
What is the primary language spoken in the home?
Household Phone Number
Your answer
Student's Guardian
Your answer
Relationship to Student
Guardian's Phone Number
Your answer
Guardian's Email Address
Your answer
Guardian's Place of Employment
Your answer
Student's Guardian
Your answer
Relationship to Student
Guardian's Phone Number
Your answer
Guardian's Email Address
Your answer
Guardian's Place of Employment
Your answer
Please list all individuals living in the household and their relationship to Student
Your answer
Emergency Contact
Your answer
Emergency Contact's Phone Number
Your answer
Relationship of Emergency Contact
Emergency Contact
Your answer
Emergency Contact's Phone Number
Your answer
Relationship of Emergency Contact
List of Individuals who have permission to pick up student
Your answer
Please list all schools previously attended by student with most recent listed first
Your answer
Is the student currently under expulsion or suspension from another school system?
Is the student currently involved with the Court System?
I grant permission for my student to ride the School Bus for school related field trips.
School Bus Transportation
I grant permission for my student to be photographed or videoed for educational and publication purposes
I grant permission for my student to participate in the school's random drug testing program (Grades 7 - 12 only)
I grant permission for my student to use the school's technology including but not limited to computers and an email account, and agree that the student will abide by the school's technology policies. A copy of the policy is found at this website: http://www.paintsville.kyschools.us/docs/district/aup.pdf
Would you like to receive information about the Free and Reduced Meal Program?
Would you like to enroll another student from this household with the same household information? If your answer is NO, you may skip the following sections and submit this form. If your answer is YES, please complete the following demographic information about any other students.
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